Structural and functional links between capsule and nephrogenic zone in fetal human kidneyhttp://www.jpnim.com/index.php/jpnim/article/view/080105
Little attention received developmental aspects of the human kidney during the late phase of gestation. For healthy newborn babies this subject has no further meaning, since nephrogenesis proceeds unnoticed until birth. Upon delivery, morphogenic activity in the nephrogenic zone is waning and progenitor cell niches aligned beyond the renal capsule disappear by an unknown mechanism. However, a comparable but too early degenerative process takes place in the kidneys of preterm and low birth weight babies. Although born in a period of active nephrogenesis, pathological findings show that they evolve to a high incidence oligonephropathy. Regarding this problematic situation, it is necessary to develop concepts for a therapeutic prolongation of nephrogenesis. However, their realization will be difficult. First, many harming molecules and metabolites, related receptors and disturbed pathways on progenitor target cells have to be identified. Due to the lack of an intact vessel system, a site-specific application of drugs is required. Morphological peculiarities of the nephrogenic zone and positioning of niches must be taken into account. Of current interest are cell biological interactions between the nephrogenic zone and the covering capsule. For example, between gestation weeks 32 and 38, an astonishingly big areal expansion of the capsule and the underlying nephrogenic zone in an order of 30% takes place. Data point out that this little-noticed process also has a special meaning for the control of continuation and cessation of nephrogenesis. Thus, the present contribution likes to inform about this network, and it is simultaneously a call for young scientists to start with investigations in a hardly explored claim. <br />Will W. Minuth2018-12-132018-12-138A possible role of GDNF expression by which cabergoline use affects corpus callosumhttp://www.jpnim.com/index.php/jpnim/article/view/080112
A variety of malformations have been associated with cabergoline use during gestation. Recently we had a preterm male infant referred to our Neonatal Intensive Care Unit diagnosed with corpus callosum agenesis confirmed by brain ultrasound and brain magnetic resonance imaging. The mother was on medication with cabergoline, due to a pituitary prolactinoma, only for the first month of pregnancy. The exact possible mechanism by witch cabergoline may have a negative effect on corpus callosum development is still unknown. Discovery of neurotrophic brain factors has opened a new chapter in the understanding of neurogenesis and synaptic plasticity mechanisms. To our knowledge, this is the first suggestion of a possible role of glial cell line-derived neurotrophic factor (GDNF) expression on corpus callosum agenesis after the administration of cabergoline in women during pregnancy.Georgios MitsiakosAnastasia Gkampeta2018-12-022018-12-028Does counseling affect parental postpartum depression?http://www.jpnim.com/index.php/jpnim/article/view/080101
<p><strong>Introduction and objectives:</strong> During pregnancy and after childbirth, parents experience new roles and responsibilities, which may affect their mood and lead to postpartum depression. The present study examines the effects of counseling on postpartum depression in parents.</p><p><strong>Materials and methods:</strong> The study is a clinical trial on 76 couples from Urmia, Iran. The samples were chosen from week 34 of pregnancy to 6 months after childbirth and randomly assigned to control (38 couples) and intervention (38 couples) groups. The control group received routine care, while parents in the intervention group received routine care plus five counseling sessions. All the women and their spouse in the control and intervention groups were assessed with the Edinburgh Postpartum Depression Scale at the beginning of study, 2 and 6 months after childbirth. Descriptive statistics tests and t-test were used to extract the results. P-values less than 0.05 were considered significant.</p><p><strong>Findings:</strong> Mean Edinburgh depression score 2 months after childbirth was higher for control group mothers (10.18 ± 1.53) as compared with the intervention group (8.21 ± 1.43). This was statistically significant. The mean Edinburgh depression scores for fathers in the control and intervention groups were 6.92 ± 1.51 and 6.36 ± 1.42, respectively, but this difference was not statistically significant. Also, the mean Edinburgh depression scores 6 months after childbirth were found to be higher for the control group mothers (p = 0.001) and fathers (p = 0.019), and this was statistically significant.</p><p><strong>Conclusion:</strong> The results of this study showed that couple-based counseling significantly decreased depression scores of nulliparous women within 2-6 months after delivery. However, the interventions failed to have effects on fathers within 2 months after childbirth and only proved statistically effective after 6 months.</p>Soheila RabiepoorAtefeh Yas2018-11-292018-11-298Perinatal palliative care following prenatal diagnosis of severe fetal anomaly: a new family-centered approach in a level III Portuguese hospitalhttp://www.jpnim.com/index.php/jpnim/article/view/080102
Perinatal palliative care (PNPC) is an emerging field that aims to improve the quality of life of families affected by an antenatal diagnosis incompatible with long-term survival through a specialized, multidisciplinary approach and holistic and emotional support. An advance care planning begins at the moment of diagnosis and continues in the postpartum period addressing comfort measures to alleviate pain, psychological support for family members and the collection of mementos that allow parents to make lasting memories of their child.<br />PNPC is also an integral part of the Newborn Individualized Developmental Care and Assessment Program (NIDCAP) in Obstetrics and Neonatology. Since 1997, there are more than 300 programs described, tailored to the newborn’s best interest.<br />Up to now, providers often feel difficulties in the implementation of PNPC programs, given the lack of evidence-based quantitative empirical studies that are necessary to establish the best model of care. Obstacles to palliative care include diagnostic and prognostic uncertainty and logistic obstacles related to interdisciplinary collaboration. Literature also suggests a great discrepancy involving end-of-life decisions between different countries.<br />This paper presents an overview of the first PNPC program implemented in a level III Portuguese neonatal intensive care unit (NICU) with two case studies providing a distinctive perspective on the support and care needed. It also seeks to serve as a resource for other institutions since there are no well-established and published guidelines regarding PNPC in Portugal. It is also important to include obstetric residents, midwives, medical students and nursing students in the provision of palliative care so this model of care can be incorporated into future practices. <br />Diana Paula Gomes GuimarãesMaria Hercília Ferreira Guimarães Pereira AreiasCarla Maria de Almeida RamalhoMaria Manuela Rodrigues2018-11-292018-11-298Childhood sacrococcygeal teratoma: a clinicopathological studyhttp://www.jpnim.com/index.php/jpnim/article/view/080116
<p><strong>Background:</strong> Sacrococcygeal teratoma (SCT) is a relatively uncommon tumor affecting neonates, infants, and children with a female preponderance. Age is an important predictor of malignancy in SCT. Early antenatal diagnosis influences the management and provides a better outcome.</p><p><strong>Aim: </strong>The present study was carried out to describe in detail various clinicopathological features and outcome of SCT patients; as many reports are available from the West, there is a paucity of literature on this entity from the Eastern region, especially India, which has a unique socioeconomic and demographic background.</p><p><strong>Materials and methods:</strong> The study included 52 patients of SCT operated for 16 years from 2000 to 2015. A retrospective review of various parameters was done from the medical case records available in the Department of Pediatric Surgery (PGIMS, Rohtak, Haryana, India).</p><p><strong>Result:</strong> There were 40 females and 12 males with age ranging from newborn to 13 years. Thirty-three children (63%) presented in the neonatal age group. There were 40 cases of benign (mature), 7 immature and 5 malignant teratomas. Four cases had a recurrence on follow-up. Out of 52 patients, 7 died while the others are doing well on follow-up.</p><p><strong>Conclusion:</strong> A prenatal diagnosis of SCT is essential for reducing morbidity and mortality. Delayed presentation and the presence of malignant changes continue to be poor prognostic factors. Strict follow-up by clinical examination, ultrasound and tumor markers is mandatory to look for any recurrence.</p>Kamal Nain RattanHemant YadavDivya SrivastavaAnanta Rattan2018-12-022018-12-028Pharmacological treatment of ceftriaxone-related cholelithiasis in children: is it worthwhile?http://www.jpnim.com/index.php/jpnim/article/view/080108
Ceftriaxone treatment of bacterial infections can be associated with biliary complications, more commonly in children than adults, in a dose-dependent manner. This study describes a clinical case series of children with ceftriaxone-related cholelithiasis.<br />We performed a retrospective analysis of cases of ceftriaxone-related biliary complications admitted to the Pediatric Clinic, Department of Clinical and Experimental Medicine, University of Sassari, Italy, during the period 2005-2015.<br />Four children with cholelithiasis occurring during, or soon after, the treatment with ceftriaxone are reported. Case 1 (6-month-old), case 2 (9-year-old) and case 4 (10-year-old) were symptomatic, while case 3 (3-year-old) was asymptomatic. After the ultrasonographic diagnosis of gallstones (cases 1 and 2) or biliary sludge (cases 3 and 4), ceftriaxone treatment was withdrawn, and ursodeoxycholic acid (UDCA) was started in cases 1 and 2. A complete recovery was observed in all but case 1, in whom cholelithiasis was still detectable at one-year follow-up by ultrasonography. This case underwent a triple antibiotic protocol for bacterial meningitis. The protocol included rifampicin, which is known to have an effect in decreasing hepatic concentration of bile salts. Therefore, in this case, both rifampicin and UDCA were of no benefit in preventing or treating ceftriaxone biliary complications. <br />The current pharmacological approach for the treatment of ceftriaxone-related cholelithiasis seems to be ineffective, likely due to the high calcium content of gallstones. Therefore, the best strategy of intervention for ceftriaxone biliary complications in children remains the prevention of the risk factors.<br />Anna Maria OggianoMaria Grazia ClementeLaura CuzzolinCristian LocciClaudia Maria PireddaKathleen B. SchwarzRoberto Antonucci2018-12-022018-12-028A quality improvement project to improve human milk feeding rate in hospitalized neonateshttp://www.jpnim.com/index.php/jpnim/article/view/080111
<p><strong>Background:</strong> Human milk feeding is a well-established key of success to improve both short- and long-term outcomes in neonates. However, human milk feeding in hospitalized neonates faces many challenges, including limited availability of lactation specialists and bedside nurses, separation issue, mothers’ and infants’ illness. Our hospital has set up this quality improvement (QI) project based on Spatz’s ten steps of breastfeeding in vulnerable infants since 2014. This is a report of our QI project outcome on breast milk feeding.<br /><strong></strong></p><p><strong>Materials and methods:</strong> This program was launched in August 2014. The QI measures to evaluate the process were the percentage of mothers starting milk expression within 4 hours and the percentage of mothers expressing milk more than 8 times/day. The outcome measure was the proportion of neonates receiving more than 50% of mother’s milk feeding during hospital stay. This project was divided into 3 phases: baseline phase, early introduction phase and sustained phase. <br /><strong></strong></p><p><strong>Results:</strong> There were 563, 643 and 614 neonates admitted during baseline phase, early phase and sustained phase, respectively. Percentage of infants which received mainly mother’s own milk gradually improved significantly from 49.8% ± 11.5% at baseline, to 63.1% ± 6.6% in the early phase, and up to 68.8% ± 9% in the sustained phase. The percentage of mothers starting to express milk within 4 hours was 60% ± 18.7% in the early phase and 51.9% ± 14.3% in the sustained phase (p = 0.242). The percentage of mothers expressing milk at least 8 times/day slightly increased from 52.5% ± 15.4% in the early phase to 61.9% ± 12.2% in the sustained phase (p = 0.146).<br /><strong></strong></p><p><strong>Conclusions:</strong> Implementation of QI project based on Spatz’s ten steps of breastfeeding in vulnerable infants has significantly improved the rate of breast milk feeding in hospitalized neonates even in a low resource setting.</p>Sudatip KositamongkolTongta NanthakomonSonthaya Nukaw2018-12-032018-12-038Successful treatment of <em>Staphylococcus haemolyticus</em> endocarditis in extremely premature baby with daptomycinhttp://www.jpnim.com/index.php/jpnim/article/view/080109
Daptomycin is a novel lipopeptide antibiotic with rapid activity against Gram-positive bacteria including methicillin-resistant <em>Staphylococcus aureus</em>, coagulase-negative <em>Staphylococci</em>, and <em>Enterococci</em>. We are reporting the first case of successfully using daptomycin to treat infective endocarditis in an extremely premature baby.Suzan Suhail AsfourFahad AljobairIbrahim HammamiAdli AbdelrahimMountasser M. Al-Mouqdad2018-11-272018-11-278Hard cranial mass: cephalohematoma?http://www.jpnim.com/index.php/jpnim/article/view/080107
Calcified cephalohematoma is a rare condition with aesthetic implications and unknown evolution. The history is typically described as a firm fluctuant parietal mass presented from birth that develops into a hard calcified mass. The diagnosis is based on clinical and imaging findings. Skull radiography is essential and accessible, but in cases where surgical approach is considered, magnetic resonance imaging helps to characterize the mass. We present the case of a 3-month-old infant living in São Tomé and Príncipe, with normal psychomotor development and history of cephalohematoma at birth. He attends pediatric consultation presenting a hard swelling with 2 months of evolution in the left parietal region. The skull radiograph was compatible with a calcified cephalohematoma. Since there was no access to neurosurgery and magnetic resonance, a conservative approach was chosen with follow-up in pediatric consultation.<br />Fábia CarvalhoInês de MedeirosFlavia CorreaFeliciana Sousa PontesMárcio Amado2018-12-122018-12-128